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Kondal D, Awasthi A, Patel SA, Chang HH, Ali MK, Deepa M, Mohan S, Mohan V, Narayan KMV, Tandon N, Prabhakaran D. Evaluating bias with loss to follow-up in a community-based cohort: empirical investigation from the CARRS Study. J Epidemiol Community Health 2024; 78:220-227. [PMID: 38199804 DOI: 10.1136/jech-2023-220963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Retention of participants is a challenge in community-based longitudinal cohort studies. We aim to evaluate the factors associated with loss to follow-up and estimate attrition bias. METHODS Data are from an ongoing cohort study, Center for cArdiometabolic Risk Reduction in South Asia (CARRS) in India (Delhi and Chennai). Multinomial logistic regression analysis was used to identify sociodemographic factors associated with partial (at least one follow-up) or no follow-up (loss to follow-up). We also examined the impact of participant attrition on the magnitude of observed associations using relative ORs (RORs) of hypertension and diabetes (prevalent cases) with baseline sociodemographic factors. RESULTS There were 12 270 CARRS cohort members enrolled in Chennai and Delhi at baseline in 2010, and subsequently six follow-ups were conducted between 2011 and 2022. The median follow-up time was 9.5 years (IQR: 9.3-9.8) and 1048 deaths occurred. Approximately 3.1% of participants had no follow-up after the baseline visit. Younger (relative risk ratio (RRR): 1.14; 1.04 to 1.24), unmarried participants (RRR: 1.75; 1.45 to 2.11) and those with low household assets (RRR: 1.63; 1.44 to 1.85) had higher odds of being lost to follow-up. The RORs of sociodemographic factors with diabetes and hypertension did not statistically differ between baseline and sixth follow-up, suggesting minimal potential for bias in inference at follow-up. CONCLUSION In this representative cohort of urban Indians, we found low attrition and minimal bias due to the loss to follow-up. Our cohort's inconsistent participation bias shows our retention strategies like open communication, providing health profiles, etc have potential benefits.
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Affiliation(s)
- Dimple Kondal
- Centre for Chronic Disease Control, New Delhi, India
| | - Ashish Awasthi
- Centre for Chronic Disease Control, New Delhi, India
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
| | - Shivani Anil Patel
- Emory Global Diabetes Research Center,Woodruff Health Sciences Center, Emory University, Atlanta, Georgia, USA
| | - Howard H Chang
- Emory Global Diabetes Research Center,Woodruff Health Sciences Center, Emory University, Atlanta, Georgia, USA
| | - Mohammed K Ali
- Emory Global Diabetes Research Center,Woodruff Health Sciences Center, Emory University, Atlanta, Georgia, USA
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Mohan Deepa
- Epidemiology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Sailesh Mohan
- Centre for Chronic Disease Control, New Delhi, India
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
| | - Viswanathan Mohan
- Diabetology, Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - K M Venkat Narayan
- Emory Global Diabetes Research Center,Woodruff Health Sciences Center, Emory University, Atlanta, Georgia, USA
| | - Nikhil Tandon
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
- All India Institute of Medical Sciences, New Delhi, India
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
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Murarkar S, Pokale A, Gothankar J, Deshmukh R, Gupta V. Prevalence of hypertension and associated risk factors in urban slums: A community based cross sectional study in India. Indian J Public Health 2023; 67:474-476. [PMID: 37929395 DOI: 10.4103/ijph.ijph_1636_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Hypertension is a global public health issue. Being a silent killer, very rarely symptoms are seen in the early stages till a severe medical crisis (heart attack, stroke, or chronic kidney disease) occurs. A community-based cross-sectional study was conducted to estimate the prevalence of hypertension in urban slums and to evaluate the association of hypertension with various modifiable and nonmodifiable risk factors. Data were collected by house-to-house visits in the slums. Pro forma created in the Magpi app was used to collect demographic characteristics and record anthropometric findings. SPSS version 25 was used for statistical analysis. Of the 534 participants, 71.91% were female. The prevalence of hypertension was found to be 15.36%. The risk of hypertension increased with age >50 years, female gender, and habits such as tobacco and alcohol. Awareness programs to reduce modifiable risk factors such as smoking and alcohol, promoting healthy lifestyles, as well as early diagnosis and treatment, will benefit the community.
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Affiliation(s)
- Sujata Murarkar
- Associate Professor, Department of Community Medicine, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, Maharashtra, India
| | - Aarati Pokale
- Associate Professor, Department of Community Medicine, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, Maharashtra, India
| | - Jayashree Gothankar
- Professor and Head, Department of Community Medicine, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, Maharashtra, India
| | - Rupeshkumar Deshmukh
- Biostatistician, Department of Community Medicine, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, Maharashtra, India
| | - Vidit Gupta
- MBBS Student, Department of Community Medicine, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, Maharashtra, India
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Mizutani M, Tashiro J, Sugiarto H, Maftuhah, Riyanto, Mock J, Nakayama K. Identifying correlates of salt reduction practices among rural, middle-aged Muslim Indonesians with hypertension through structural equation modeling. Nutr Health 2023; 29:85-95. [PMID: 35014883 DOI: 10.1177/02601060211057624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: In 2016, the World Health Organization recommended salt reduction strategies. In most low- and middle-income countries, little is known about what causes people to reduce their salt intake. Aim: In rural West Java, Indonesia, we conducted a cross-sectional survey to describe self-reported salt reduction practices among middle-aged Muslims with hypertension (n = 447) and to identify correlates of salt reduction. Methods: We developed a questionnaire with Likert scales to measure self-reported frequency of efforts to reduce salt intake, and degree of agreement/disagreement with 51 statements about variables hypothesized to influence salt reduction practices. We compared groups using t-tests and one-way ANOVAs. Through one-factor confirmatory factor analysis and structural equation modeling, we identified correlates of salt reduction practices. Results: About 45% of participants reported regularly reducing their salt intake; only 12.8% reported never attempting. Men reported higher social barriers, while women reported higher family support and spiritual support. Overall, we found that participants' frequency of effort to reduce their salt intake was associated with a constellation of six correlates. Salt reduction practices were directly positively associated with prior health/illness experiences (β = 0.25), and by seeking health information (β = 0.24). Seeking health information was in turn positively associated with prior health/illness experiences (β = 0.34), receiving support from health professionals (β = 0.23) and Islamic spiritual practice (β = 0.24). Salt reduction practices were negatively associated with environmental barriers to healthful eating practices (β = -0.14). Conclusion: In this population, reinforcing positive correlates identified in this study and mitigating against negative correlates may foster salt reduction practices.
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Affiliation(s)
- Mayumi Mizutani
- Department of Public Health Nursing, 88369Mie University Graduate School of Medicine, Tsu, Mie, Japan.,Graduate School of Nursing Science, St Luke's International University, Tokyo, Japan
| | - Junko Tashiro
- Graduate School of Nursing Science, St Luke's International University, Tokyo, Japan
| | - Heri Sugiarto
- 188408Indramayu College of Health Science, Indramayu, West Java, Indonesia
| | - Maftuhah
- 118942Syarif Hidayatullah State Islamic University Jakarta, Tangerang Selatan, Banten, Indonesia
| | - Riyanto
- 188408Indramayu College of Health Science, Indramayu, West Java, Indonesia
| | - Jeremiah Mock
- Institute for Health & Aging and Department of Social and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Kazuhiro Nakayama
- Graduate School of Nursing Science, St Luke's International University, Tokyo, Japan
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Mohammadi S, Hassanipour S, Delam H, Nikbakht HA, Ghaem Far Z, Firoozi D, Ghaem Far E, Abdolazimi H, Ghaffarian-Bahraman A. Prevalence of hypertension in Iran: An updated systematic review and meta-analysis of community-based studies. CASPIAN JOURNAL OF INTERNAL MEDICINE 2023; 14:607-617. [PMID: 38024178 PMCID: PMC10646369 DOI: 10.22088/cjim.14.43.607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/20/2023] [Accepted: 04/05/2023] [Indexed: 12/01/2023]
Abstract
Background Hypertension (HTN) is one of the primary risk factors for heart disease and stroke worldwide. The present meta-analysis was aimed to systematically review and statistically estimate the prevalence rate of pre-hypertension (PHTN) and HTN in the Iranian child/adolescent and adult age groups. Methods In this study, four International databases, including PubMed, Scopus, Web of Science, and Cochrane, as well as three Iranian databases, including SID, Magiran, and IranMedex, were separately investigated for articles published before January 2021. Also, we estimated the pooled effect size for the prevalence of PHTN and HTN in children/adolescent and adult age groups. Stata software (version 14.0) was used for all statistical analyses. Results From a total of 1185 articles found in database searches, fifty-one were included in the meta-analysis. The prevalence of HTN in the Iranian adult population was 26.26% (25.11 % and 26.22 % for women and men, respectively). Meanwhile, the prevalence of PHTN and HTN in the child/adolescent age group was 8.97% (95% CI 7.33 - 10.61) and 8.98% (95% CI 7.59 - 10.36), respectively. Conclusions This study provides information which can be used for various purposes, including study designing. Further nationwide surveys should be carried out to obtain accurate information on the HTN prevalence rate, particularly based on the American College of Cardiology /American Heart Association guidelines in the Iranian population.
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Affiliation(s)
- Salman Mohammadi
- Department of Nutrition, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Soheil Hassanipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Hamed Delam
- Student Research Committee, Larestan University of Medical Sciences, Larestan, Iran
| | - Hossein-Ali Nikbakht
- Social Determinants of Health Research Center, Health Research Institute, Department of Biostatistics and Epidemiology, Faculty of Public Health, Babol University of Medical Sciences, Babol, Iran
| | - Zohreh Ghaem Far
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Donya Firoozi
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elnaz Ghaem Far
- Department of Clinical Nutrition, South Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Hamid Abdolazimi
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Ghaffarian-Bahraman
- Occupational Environment Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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Shivashankar R, Sharma B, Moran AE, Pathni AK. Validation of a Practical Approach to Blood Pressure Measurement: Secondary Analysis of Data from a Nationally Representative Survey in India. Glob Heart 2021; 16:87. [PMID: 35141128 PMCID: PMC8698233 DOI: 10.5334/gh.1085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 11/15/2021] [Indexed: 01/09/2023] Open
Abstract
Background Clinical guidelines differ on the recommended number of blood pressure (BP) measurements for hypertension diagnosis in primary health care settings. We assessed the accuracy in identifying high BP (≥140/90 mmHg) and efficiency (mean BP measures per person in one visit) of a practical BP measurement approach against the research standard. Methods We analyzed data from a national survey in India with three BP measurements for each adult participant (N = 372,110). The research standard (referred to as 'standard approach') is measuring three BP and using the mean of the last two. In the practical approach, the first BP reading was used if the measure was <140/90 mmHg; the second BP was used if the first BP was ≥140/90 mmHg. If the difference between either the first two systolic or diastolic BPs was >5 mmHg, then we used the third reading. Results Prevalence of high BP was 15.5% and 14.9% using standard and practical approaches, respectively. The sensitivity, specificity, false positive, and false negative rates of the practical approach were 85.4%, 98.0%, 11.3%, and 2.7% compared to the standard approach. The practical approach was more resource-efficient (mean BPs/person/visit 1.4 versus 3.0 for the standard approach). The practical approach had similar validity, but higher efficiency compared to other internationally recommended BP measurement protocols. Conclusion The practical BP measurement approach has high validity, is simpler and involves a lower measurement burden on health care providers and can improve the utility of BP measurement, hypertension diagnosis, and management in busy primary health care settings.
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Affiliation(s)
| | | | - Andrew E. Moran
- Resolve to Save Live, Vital Strategies, New York, US
- Columbia University Irving Medical Center, New York, US
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Philip R, Beaney T, Appelbaum N, Gonzalvez CR, Koldeweij C, Golestaneh AK, Poulter N, Clarke JM. Variation in hypertension clinical practice guidelines: a global comparison. BMC Med 2021; 19:117. [PMID: 33975593 PMCID: PMC8114719 DOI: 10.1186/s12916-021-01963-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/17/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Hypertension is the largest single contributor to the global burden of disease, affecting an estimated 1.39 billion people worldwide. Clinical practice guidelines (CPGs) can aid in the effective management of this common condition, however, inconsistencies exist between CPGs, and the extent of this is unknown. Understanding the differences in CPG recommendations across income settings may provide an important means of understanding some of the global variations in clinical outcomes related to hypertension. AIMS This study aims to analyse the variation between hypertension CPGs globally. It aims to assess the variation in three areas: diagnostic threshold and staging, treatment and target blood pressure (BP) recommendations in hypertension. METHODS A search was conducted on the MEDLINE repository to identify national and international hypertension CPGs from 2010 to May 2020. An additional country-specific grey-literature search was conducted for all countries and territories of the world as identified by the World Bank. Data describing the diagnosis, staging, treatment and target blood pressure were extracted from CPGs, and variations between CPGs for these domains were analysed. RESULTS Forty-eight CPGs from across all World Bank income settings were selected for analysis. Ninety-six per cent of guidelines defined hypertension as a clinic-based BP of ≥140/90 mmHg, and 87% of guidelines recommended a target BP of < 140/90 mmHg. In the pharmacological treatment of hypertension, eight different first-step, 17 different second-step and six different third-step drug recommendations were observed. Low-income countries preferentially recommended diuretics (63%) in the first-step treatment, whilst high-income countries offered more choice between antihypertensive classes. Forty-four per cent of guidelines, of which 71% were from higher-income contexts recommended initiating treatment with dual-drug therapy at BP 160/100 mmHg or higher. CONCLUSION This study found that CPGs remained largely consistent in the definition, staging and target BP recommendations for hypertension. Extensive variation was observed in treatment recommendations, particularly for second-line therapy. Variation existed between income settings; low-income countries prescribed cheaper drugs, offered less clinician choice in medications and initiated dual therapy at later stages than higher-income countries. Future research exploring the underlying drivers of this variation may improve outcomes for hypertensive patients across clinical contexts.
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Affiliation(s)
- Richu Philip
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Thomas Beaney
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Nick Appelbaum
- Helix Centre for Design in Healthcare, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Carmen Rodriguez Gonzalvez
- Helix Centre for Design in Healthcare, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Charlotte Koldeweij
- Helix Centre for Design in Healthcare, Institute of Global Health Innovation, Imperial College London, London, UK
| | | | - Neil Poulter
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Jonathan M Clarke
- Centre for Mathematics of Precision Healthcare, Department of Mathematics, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK.
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Ismail IM, Nandy S, Adhikari S, Tm R, Gupta D, M D, Ranjan A, Aboobacker A. Time to Switch to 'Rule of Three-Quarters' from 'Rule of Halves' in Hypertension? A Descriptive Study from Dakshina Kannada, South India. Cureus 2021; 13:e13142. [PMID: 33692916 PMCID: PMC7937012 DOI: 10.7759/cureus.13142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background ‘Rule of halves’ depicts the overall picture of hypertension that prevails in a community. This study was taken up to understand if the traditional ‘rule of halves’ of hypertension still prevails or is it time to shift to the proposed ‘rule of three-quarters’. The objectives of the study were: to estimate (i) the prevalence of hypertension among adult residents of Madani Nagar rural community in the Dakshina Kannada district of Karnataka state in southern India, (ii) the proportion who are aware of their disease among hypertensive patients, (iii) the proportion who are on treatment among those who are aware of their disease, and (iv) the proportion having adequate blood pressure control among those on treatment. Materials and methods This was a cross-sectional study carried out in Madani Nagar, Dakshina Kannada from February to April 2020. Complete enumeration method was followed and all adults aged ≥ 18 years who consented were included in the study. Data collection was done using a pre-validated questionnaire and blood pressure was recorded as per World Health Organization guidelines. Results A total of 661 individuals were enrolled in the study. The prevalence of hypertension was 29.2%. Only 55.4% of hypertensive patients were aware that they had the disease, and among them, 96.3% were on treatment. Among those on treatment, 58.3% had adequate control of blood pressure. Conclusion The hypertension pattern of the community leans more towards the traditional ‘rule of halves’ of hypertension and it is still a long way ahead until the proposed ‘rule of three-quarters’ can be achieved.
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Affiliation(s)
| | | | | | - Revathi Tm
- Community Medicine, Yenepoya Medical College, Mangaluru, IND
| | - Dhruv Gupta
- Community Medicine, Yenepoya Medical College, Mangaluru, IND
| | - Deeptha M
- Community Medicine, Yenepoya Medical College, Mangaluru, IND
| | - Awnish Ranjan
- Community Medicine, Yenepoya Medical College, Mangaluru, IND
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Rai RK, Kumar C, Singh PK, Singh L, Barik A, Chowdhury A. Incidence of Prehypertension and Hypertension in Rural India, 2012-2018: A Sex-Stratified Population-Based Prospective Cohort Study. Am J Hypertens 2020; 33:552-562. [PMID: 32149333 DOI: 10.1093/ajh/hpaa034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/20/2020] [Accepted: 03/04/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND India is home to the largest number of hypertensive individuals, and factors responsible for the incidence of hypertension are poorly understood. This study examines predictors of transition to different stages of hypertension-incidence of hypertension, incidence of prehypertension, and incidence of prehypertension to hypertension. METHODS Population-based survey data from the Birbhum Population Project, located in West Bengal, India were used. A cohort of 8,977 individuals (male: 3,934, female: 5,043), participated in the 2012-13 survey, and were followed up for resurvey in 2017-18. The Seventh Report of the Joint National Committee (JNC 7) guidelines were followed to define hypertension. Bivariate and multivariate Poisson regression analyses were conducted to attain the study objective. RESULTS The incidence of hypertension, prehypertension among males (7.9% and 45.3%, respectively) is higher than that among females (5.9% and 32.7%, respectively). However, the incidence of prehypertension to hypertension is lower among males (23.6%) than among females (33.6%). Among both sexes, with age, the incidence of hypertension, and incidence of prehypertension to hypertension appeared to increase, whereas incidence of prehypertension among females increased with age. Findings indicate a diverse gradient of socioeconomic, behavioral, and anthropometric characteristics influencing the incidence of different stages of hypertension. CONCLUSIONS With a focus on females and the richest individuals, this study proposes that an appropriate intervention be designed in keeping with the socioeconomic, behavioral gradient of incidence of different stages of hypertension. The role of anthropometric indicators in hypertension is proposed to be further studied for better population-based screening.
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Affiliation(s)
- Rajesh Kumar Rai
- Society for Health and Demographic Surveillance, Suri, West Bengal, India
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA
- Department of Economics, and Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany
| | - Chandan Kumar
- Department of Policy Studies, TERI School of Advanced Studies, New Delhi, India
| | - Prashant Kumar Singh
- Division of Preventive Oncology, ICMR National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Lucky Singh
- ICMR National Institute of Medical Statistics, New Delhi, India
| | - Anamitra Barik
- Society for Health and Demographic Surveillance, Suri, West Bengal, India
- Chest Clinic—Suri District Hospital, and Niramoy TB Sanatorium, Suri, West Bengal, India
| | - Abhijit Chowdhury
- Society for Health and Demographic Surveillance, Suri, West Bengal, India
- Department of Hepatology—School of Digestive and Liver Diseases, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
- Indian Institute of Liver and Digestive Sciences, Kolkata, West Bengal, India
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